By articulating a Peircean strain of bioethical inquiry, Elizabeth Cooke admirably attempts to avert the anti-realism, subjectivism and focus on consensus that afflict much so-called “pragmatic” bioethics. Yet, like many of her Deweyan colleagues, she falls prey to the egalitarian conviction that inquiry should be undertaken by huge numbers of like-minded individuals, proceeding in accordance with an authoritative canon of rules of discourse. In this essay, I argue that Cooke's egalitarianism is inconsistent with her apparent commitment to Peirce, and that (...) an alternative, libertarian account of inquiry is better and truer to Peirce. (shrink)
This issue of CQ was conceived in Salt Lake City, at the third annual meeting of the American Society of Bioethics and Humanities (ASBH). There, President-elect Laurie Zoloth delivered a stirring address, emphasizing the role of bioethics in responding to social deprivations and suggesting that ASBH on important issues where members share consensus. Not all the stirrings were pleasant. Debate erupted about the propriety of consensus statements, especially regarding possible deleterious effects on academic discourse, misappropriation of dues, and the proliferation (...) of quasi-political factions. The roots of this controversy extend deeply into the collective psyche of contemporary bioethics. (shrink)
Thomas Hobbes is one of the most ardent and thoroughgoing opponents of participatory democracy among Western political philosophers. Though Hobbes 's alternative to participatory democracy - assent by subjects to rule by an absolute sovereign - no longer constitutes a viable political alternative for Westerners, his critique of participatory democracy is a potentially valuable source of insight about its liabilities. This essay elaborates five theses from Hobbes that stand as cogent warnings to those who embrace participatory democracy, especially those advocating (...) for deliberative democracy based on a rational consensus model. In light of these warnings, the author suggests an alternative, modus vivendi approach to deliberative democracy that would radically alter the current practice of bioethics. (shrink)
The concept of autonomy as self-sovereignty is developed in this essay through an examination of the thought of American transcendentalist philosophers Emerson and Thoreau. It is conceived as the quality of living in accordance with one’s inner nature or genius. This conception is grounded in a transcendentalist moral anthropology that values independence, self-reliance, spirituality, and the capacity to find beauty in the world. Though still exerting considerable popular and academic influence, both the concept of autonomy as self-sovereignty and the underlying (...) anthropology diverge in important ways from counterparts that are prominent in contemporary bioethics. Autonomy as self-sovereignty calls into question the manifold ways that patients (and citizens) are brought to heel by institutional (and political) values they do not themselves affirm. It also emphasizes the inevitable deep plurality of moral visions of health and appropriate healthcare, rejecting tendencies (strong in mainstream bioethics) to regard “health” as a univocal concept or healthcare as a basic need, to attempt to conform “reasonable” clinical decision-making to a single model, and to appoint government as a guarantor of access to healthcare or a regulator of healthcare standards. Autonomy as self-sovereignty, like its competitors, can justify itself only in question-begging terms. Still, bioethics might do well to recognize it within the mix of moral visions. (shrink)
In speculating on the motives for government, English philosopher Thomas Hobbes identified the pervasive role of fear and the danger of violent death, holding famously that where no government prevails to secure physical safety and property, there can also be no enduring knowledge, art, or civilization—leaving human lives “solitary, poore [sic], nasty, brutish and short.”.
Contemporary bioethics begins with the perception that medical values are a matter of public, rather than merely professional, interest. Such was the message of delegates in Helsinki and of the New Jersey court that decided for Quinlan. It is a theme that lurks within almost every major bioethical treatise since the first edition of PrinciplesofBioethics. This perception also undergirds the increasingly popular suggestion that moral authority in the patient-physician relationship resides neither in the medical profession, nor in the singular will (...) of the patient, but in moral communities that link both parties with higher social orders. (shrink)
In a recent issue of CambridgeQuarterlyofHealthcareEthics, Howard Brody and Lawrence Schneiderman offer contrasting opinions about how to apply the concept of in medicine. Brody holds that are those in which it is reasonably certain that a given intervention when applied for the purpose of attaining a specific clinical goal. To determine which actions are futile, Brody prescribes a division of labor. Patients are charged with choosing the goals of treatment while physicians are charged with determining whether specific treatments will be (...) effective in achieving these goals. Though physicians do not choose specific goals, Brody thinks they have a prerogative to decide whether they can, in good conscience, aid in the achievement of specific patient goals. Let us use to denote choosing between alternative goals and to denote choices about whether one will assist in the pursuit of particular goals. Brody's position is essentially that patients are positive validators and that physicians are negative validators. Brody concludes that treatments that are effective in achieving patients' goals are not futileFutilitypromote a goal that both agree is desirable.”. (shrink)
According to Native American myths, there once roamed an Eye Juggler—a humanoid deity who could detach his eyes and juggle them. His talents were of no special appeal to members of the various tribes, given that it is quite possible to hunt buffalo, prepare meals, or play stickball without tossing around your eyes. However, there was a white man who grew interested in the Eye Juggler. Sensing great utility in detachable eyes—for spying, or looking two ways at once—the white man (...) formulated a deal. He would trade away his wealth in return for the Eye Juggler's gift. To this proposition the Juggler agreed, but also issued a warning. If the eyes stay detached for very long, they rot and cannot be used. (shrink)
Old habits die slowly. Hence there is little surprise that attorneys fashioning the Model State Emergency Health Powers Act preserved much of their own standard operating procedure. This model statute was designed for the worst of times—for horrific scenarios in which terrorism, infectious disease, or natural calamity threaten to derail the machinery of civilization while snuffing out thousands or even millions of human lives. Such grave threats seem to justify grave measures aimed at restoring order and maximizing survival. So, the (...) model statute bestows sweeping power on state governors and public health officials, allowing them to seize private property, obtain clinical services through impressment, and enact quarantine and isolation measures without the usual due process. Yet amid all these drastic measures, certain standards persist. (shrink)
What is morality? Is “morality” something that admits of technological enhancement? What could it possibly mean for a society to have a moral imperative to morally enhance? We are compelled to take up questions like these as we move into the future of moral bioenhancement. Each article in this issue of the Journal of Medicine and Philosophy attempts to bring some clarity as to what is meant by morality, such that one could be morally obligated to morally enhance. These articles (...) broaden the scope of the question as to the nature of human morality, what might and what might not be permitted in terms of moral bioenhancement, and explore the nature of the kinds of beings humans might become—whether human or post-human—and the moral obligations that may exist toward them. (shrink)
In Holding Health Care Accountable , E. Haavi Morreim differentiates between duties of expertise and resource duties, arguing for tort liability respecting the former and contract liability respecting the latter. Though Morreim's book addresses ordinary clinical medicine, her liability scheme may also be relevant elsewhere. Focusing on disaster medicine, and especially the medical management of violent mass disasters (e.g., where terrorists have deployed weapons of mass destruction), I argue in this essay that Morreim's classification of duties still fits, but that (...) it is difficult to hold government powers accountable for their many resource and expertise duties. This difficulty is compounded by political arrangements that foist under-funded mandates for disaster services on healthcare providers. As a result of such arrangements, hospitals and clinicians are prone to liability for expenditures and clinical interventions that are beyond their scope. This problem can be mitigated, I argue, by examining and clarifying the apparent social compact between society and healthcare. (shrink)
Were terrorists ever to effectively deploy weapons of mass destruction, medical practice would be quickly transformed. Many ordinary clinicians would be asked or required to treat unfamiliar yet serious medical conditions in a setting of overwhelming urgency and impossible odds. Clinical focus would shift from doing good things for a succession of individual patients to considering many patients at once, a change that could beget loss of trust and rapport with patients. Clinicians might also experience restrictions in personal liberties and (...) appropriation of their property. The purpose of this essay is to develop a teleological framework for undertaking this transformation. In ordinary clinical medicine, the elusiveness of the individual telos (i.e., the good for the individual) is acknowledged in procedures (such as social history taking, informed consent and outpatient scheduling) designed to protect patients' (and clinicians') prerogatives to interpret the telos for themselves. In mass casualty scenarios, on the other hand, the telos is standardized and regarded as an Immediate Object (usually as a state of affairs in which survival is maximized and permanent disability is minimized). Clinicians who provide mass casualty care will face a number of ethical challenges that can be negotiated by appealing to the political and ethical rationale, and limits, pertaining to the pursuit of aggregate survival as an Immediate Object. (shrink)
In “Ethics and the Underpinnings of Policy in Biodefense and Emergency Preparedness,” Lisa Eckenwiler advances discussion about emergency preparedness by exploring ethical commitments that shape healthcare and defense policy in an age of terrorism. Eckenwiler rightly discerns that policymakers' assumptions about controlling and containing hostile malefactors and the need for public consent regarding security measures are part of an epistemic framework that orders the current response to terrorism. Again rightly, she suggests that citizens ought to have a say in shaping (...) and interpreting such fundamental assumptions, a reductive medical model that focuses on mitigation and the management of casualties is insufficient for understanding and responding to the complex social, political, and economic factors that precipitate terrorist attacks, and there is in emergency preparedness an ethically problematic disproportion between the demands society places on public health/medical professionals and the resources society provides for them to meet these demands. She is also probably correct in claiming that, properly understood, the ethical underpinnings of public health policy are teleological in nature. (shrink)
In fall 2002, Paul Ellwood's Jackson Hole Group proposed “Heroic Pathways”—a healthcare reform concept that includes a voluntary system of portable, personal electronic medical records owned by patients and a health information pathway that is managed by patients and clinicians. This proposal, like so much of the innovative thinking in healthcare policy, is premised on the conviction that informed patients will drive healthcare changes in the near future.
As medical students we were not discouraged from introducing ourselves by saying, “Hello, I'm Dr. So-and-so,” as opposed to identifying ourselves as students. If we happened to be doing rounds with an intern or resident, the physician would introduce himself or herself as “Dr. X and over here is Dr. Y”—indicating a student. When I introduced myself as a medical student, I got the feeling that people thought it was silly or unnecessary.